June is Men’s Health month, so let’s hear it for the boys! Although many times, when we talk about pelvic health we hear it in reference to women, men have pelvic floors, too. Just like women, men can get pelvic floor dysfunction. Pelvic floor dysfunction can affect men of all ages!
Due to differences in anatomy and childbirth, women are often more susceptible to pelvic floor disorders, but men often suffer from many of the same issues like urinary incontinence, constipation, pain, and sexual dysfunction.
Let’s take a brief look at male anatomy. Males lack a vagina, but they have a prostate (a large gland that makes secretions for sperm) that sits underneath the bladder.
In males, the urethral canal (where pee leaves the bladder to exit the body) is much longer than in females.
Even though there are differences, males still have a pelvic floor (made of up many of the same muscles and ligaments as women) that support their pelvic organs and controls peeing, pooping, and sexual function.
When the pelvic floor muscles aren’t working properly, we can start to see the same issues as women. The pelvic floor muscles might be weak, tight, or have trouble doing the right thing at the right time.
SO WHAT PROBLEMS CAN THE PELVIC FLOOR MUSCLE CAUSE?
Incontinence
Men can suffer from incontinence which is ANY INVOLUNTARY leakage of urine (even if it’s just a drop or two). Several conditions can contribute to this including an enlarged prostate (BPH), prostate cancer, and weak pelvic floor muscles.
1 in 7 men is diagnosed with prostate cancer making it the second most common type of cancer in males. (Stallings Roscow, 2016) Sometimes prostate cancer requires a surgery called a radical prostatectomy, where the prostate is taken out. After this surgery, up to 87% of men have incontinence 6 months later. (Stallings Roscow, 2016)
Why is this? There are several reasons, but one of the biggest reasons is that removing the prostate decreases the physical support of the bladder. The bladder normally sits on top of the prostate, and removing the prostate can let the bladder fall slightly, contributing to incontinence.
Some studies have shown that pelvic floor muscle training BEFORE prostate removal surgery can help to improve symptoms like urine control and erectile dysfunction.
If the prostate is larger than normal (like in conditions like BPD) this can cause extra pressure on the bladder and urethra, making you have to go more frequently and more urgently.
Sexual Dysfunction
The pelvic floor muscles help with arousal, pleasure, and orgasm during sex. If they aren’t working properly, this can lead this can lead to erectile dysfunction, leaking urine with orgasm, premature ejaculation, and anorgasmia (lack of orgasm).
Pelvic floor muscle training can help with these problems. Studies have actually shown that having more orgasms may help you to live longer (Davey,1997; Friedman, 2011), so don’t wait to address these problems!
Pelvic Pain
Just like women, men can suffer from chronic pelvic pain, sometimes called “chronic prostatitis.” (Davia, 2014) These can lead to urination problems, sexual dysfunction, and depression. (Davia, 2014)
It is important to see a healthcare provider if you are having pelvic pain because it can be a symptom of an infection.
Pelvic pain can be caused by, you guessed it: your pelvic floor muscles! Muscles in and around the pelvic floor can become tight and painful just like any other muscle in your body—the only difference is, we can’t see these muscles.
But the good news is, these muscles can be treated and strengthened like the rest of our muscles.
Diastasis Recti
You may have heard of a diastasis recti in pregnant women, but they can occur in men, especially as they age. A diastais recti is a separation or widening of the linea alba between the rectus abdominis muscles of the abdomen. (McConville, 2019) Basically, the tissue between your “six pack” muscles becomes stretched or separated. This can cause bulging of the abdomen, especially with activities that stress that area (like when doing a crunch exercise).
Studies have shown that a diastasis recti in men can cause low back pain and decreased efficiency of the pelvic floor muscles. There are some studies that link diastasis recti with abdominal aortic aneurysm in men which is a life threatening emergency.
What Can We Do?
The good news is that pelvic floor physical therapy can help to address all of these issues! A dedicated and expert pelvic floor physical therapist will develop and coordinate a treatment plan especially for you. They will want to talk with you and discuss your concerns privately. The therapist will ask questions about your medical history, bladder and bowel function, and sexual function to better understand your condition and to develop a treatment plan that is individualized to you.
After the examination, the pelvic floor therapist may give you exercises, diet modifications, and other tips to help manage and improve your symptoms.
Men, are you ready to take control of your life back? Here are some steps you can take now:
Ask your healthcare provider for a referral to a pelvic therapist.
Find a pelvic therapist on your own at myPFM.com. We have links to 4 free searchable databases under Find a PT.
Check out our Intro to Male Pelvic Health course with Gerard Greene, PT.
Watch our YouTube video with Gerard Greene, PT on male pelvic pain during COVID19.
Watch our YouTube video with Jo Milios, PT on pelvic health for men.
Watch our YouTube video with Dr. Susie Gronski, DPT, PRPC, WCS on tips for premature ejaculation.
Watch our YouTube video with Dr. Nicholas Vernola Jr., PT on erectile dysfunction.
Watch our instagram video on the dangers of jelqing.
Learn more about the pelvic floor muscles with our book: My Pelvic Floor Muscles The Basics: Learn where the pelvic floor muscles are, what they do, and how they work
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Visit our Instagram page for more on pelvic health.
What experiences or tips do you have that can help others? We’d love to hear them. Please join the conversation in the comments section below.
By Emily Reul, PT, DPT
References
1. Stallings Roscow A, Borello-France D. Treatment of male urinary incontinence post-radical psotatectomy using physical thearpy interventions. J Womens Health Phys Therap. 2016; 40(3)129-138.
DOI: 10.1097/JWH.0000000000000064
2. Davia J, Welty A. Manual therapy and education for physical therapy management of male chronic pelvic pain syndrome. J Womens Health Phys Therap. 2014;38(1)3-10. DOI: 10.1097/JWH.0000000000000007
3.McConville MQ, Schilz J, Doerfler D, Andrews R. A review of literature on the diagnosis, clinical implications, and treatment of diastasis recti in older males. J Womens Health Phys Therap. 2019;43(4)202-208. OI: 1 0.1097/JWH.0000000000000150
4. Davey Smith G, Frankel S, Yarnell J. Sex and death: are they related? Findings from the Caerphilly Cohort Study. BMJ. 1997 Dec 20-27;315(7123):1641-4. doi:10.1136/bmj.315.7123.1641
5. Friedman HS. The Longevity Project: Surprising Discoveries for Health and Long Life from the Landmark Eight-Decade Study. Hudson Press; 2011.